Comparative Analysis of Treatment Outcomes and Prognostic Factors in Early T-Precursor Versus Non-ETP Acute Lymphoblastic Leukemia Following Allogeneic Hematopoietic Stem Cell Transplantation in Adolescents and Young Adults.
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This study evaluates the outcomes and risk factors associated with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adolescents and young adults (AYA) diagnosed with early T-precursor (ETP) acute lymphoblastic leukemia (ALL) compared to non-ETP ALL.We retrospectively analyzed 178 AYA patients with T-ALL who were treated between September 2014 and December 2022. Out of 178 patients, 128 underwent allo-HSCT, with a median age of 25 years (range: 18-35). Among them, 49 were in the ETP group and 79 in the non-ETP group. Neutrophil and platelet engraftment times were comparable between groups. 3-year OS rates were 67.3% for ETP and 65.8% for non-ETP patients; 3-year LFS rates were 65.3% and 65.8%, respectively, showing no significant difference. Cumulative incidence of relapse (22.1% vs. 21.6%) and non-relapse mortality rates (17.8% vs. 13.7%) were similar. The incidence of acute and chronic GVHD, along with infections, showed no significant differences. Multivariable analysis revealed first complete remission before transplantation as a positive predictor for OS and LFS in non-ETP patients. In ETP patients, a white blood cell count below 30 × 109/L predicted better LFS outcomes. A hemoglobin level below 120 g/L was independently associated with improved OS in non-ETP patients. Allo-HSCT offers effective improvement in prognosis for ETP-ALL, with survival outcomes comparable to non-ETP ALL patients.